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J Child Psychol Psychiatry. 2016 Nov;57(11):1218-1226. doi: 10.1111/jcpp.12549. Epub 2016 Mar 17.

A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents.

Author information

1
Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
2
Harvard Medical School, Boston, MA, USA.
3
Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. ssafren@miami.edu.
4
Harvard Medical School, Boston, MA, USA. ssafren@miami.edu.
5
Department of Psychology, University of Miami, Miami, FL, USA. ssafren@miami.edu.
6
Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
7
Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.

Abstract

OBJECTIVE:

To test cognitive behavioral therapy (CBT) for persistent attention-deficit hyperactivity disorder (ADHD) symptoms in a sample of medication-treated adolescents.

METHODS:

Forty-six adolescents (ages 14-18), with clinically significant ADHD symptoms despite stable medication treatment were randomly assigned to receive CBT for ADHD or wait list control in a cross-over design. Twenty-four were randomized to CBT, 22 to wait list, and 15 crossed-over from wait list to CBT. A blind independent evaluator (IE) rated symptom severity on the ADHD Current Symptom Scale, by adolescent and parent report, and rated each subject using the Clinical Global Impression Severity Scale (CGI), a global measure of distress and impairment. These assessments were performed at baseline, 4-months (post-CBT or post wait list), and 8-months (post-treatment for those originally assigned to the wait list condition and 4-month follow-up for those originally assigned to CBT).

TRIAL REGISTRATION:

http://clinicaltrials.gov/show/NCT01019252.

RESULTS:

Using all available data, mixed effects modeling, and pooling for the wait list cross-over, participants who received CBT received a mean score 10.93 lower on the IE-rated parent assessment of symptom severity (95% CI: -12.93, -8.93; p < .0001), 5.24 lower on the IE-rated adolescent assessment of symptom severity (95% CI: -7.21, -3.28; p < .0001), and 1.17 lower IE-rated CGI (95% CI: -1.39, -.94; p < .0001). Results were consistent across 100 multiple imputations (all p < .0001). There was a greater proportion of responders after CBT by parent (50% vs. 18%, p = .00) and adolescent (58% vs. 18% p = .02) report.

CONCLUSIONS:

This study demonstrates initial efficacy of CBT for adolescents with ADHD who continued to exhibit persistent symptoms despite medications.

KEYWORDS:

ADHD ; adolescence; behavior therapy; cognitive therapy

PMID:
26990084
PMCID:
PMC5026858
DOI:
10.1111/jcpp.12549
[Indexed for MEDLINE]
Free PMC Article

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